The NHS in 2017

WHETHER you agree with the Red Cross that the crisis in social care and the NHS is ‘humanitarian’, or merely ‘human’, there is no doubt that millions of people are being denied the care they need or waiting too long for it.
Christmas was particularly bad, with a third of hospitals having to take urgent action to safeguard patients and reports of staff meltdown and deaths in the corridor queues. With so many hospitals overcrowded and on red alert, now does not seem to be the time for the massive cuts in bed numbers predicted by the McKinsey-heavy NHS Sustainability and Transformation Plans.
This crisis has been a long time coming. In September 2016, 32 percent of the most urgent ambulance calls weren’t responded to in eight minutes, the worst ever performance for that month. In quarter two of 2016/17, 9.4 percent of patients (558,000) waited more than four hours from arrival to discharge, admission or transfer in all A&E departments, the highest percentage for this quarter since 2003/4. More than 107,600 patients waited more than four hours for a hospital bed, up 70 percent on last year.
At the end of September more than 348,500 patients had been waiting 18 weeks or longer to begin treatment (up 9.4 percent on the previous September). More than 1,181 of these patients had been waiting more than a year. It was the seventh month in a row the target of 8 percent had been breached – the worst performance since that target was introduced in April 2012.
In September 2016 the total reported waiting list increased to 3.7m, an increase of more than 411,470 patients compared to January 2016. Some trusts have given up reporting but even NHS England estimates the true waiting list in September 2016 was more than 3.9m patients, the highest since December 2007. The proportion of patients waiting more than six weeks for a diagnostic test has now missed its target for the past 34 months in a row.
The overall waiting times target for cancer treatment is that no more than 15 percent of patients should wait more than 62 days from an urgent referral from their GP to receiving treatment for their cancer. This standard has not been met for the past two and a half years, and is up to 17.7 percent.
At the end of September 2016, 6,775 patients were delayed in hospitals, the highest number ever published and an increase of 29 percent since September 2015. The number of total days delayed increased to more than 196,000 in September 2016, the highest ever recorded and a 33 percent annual increase.
The number of urgent operations cancelled in November alone was 446, double the previous year. This prompted Jim Mackey, chief executive of NHS Improvement, to advise hospitals to cancel routine operations over Christmas to make way for emergencies. Children’s intensive care units in particular are struggling to cope.
The crisis in general practice is clear too. According to a 2016 survey of 831 practices by Pulse magazine, the average wait for a routine GP appointment is nearly two weeks, with a prediction it will rise to 17 days in 2017. 12 percent of practices surveyed in 2016 already had waits of three to four weeks.
The reasons for this ever-declining NHS performance are well known. Rising demand, flat-line funding, cuts in social care, inadequate investment in staff and community services, waste and lack of coordination in a marketised, fragmented service. Thus Tory manifesto pledges look absurd, particularly this one: “We will offer you the safest and most compassionate care in the world.”
UK health spending is just over 8 percent of GDP. France, Sweden, Denmark and Belgium spend 10-11 percent. There is no “right” amount to spend on the NHS, but the delusion that we can have the safest, most compassionate service in the world for so little must stop. Most NHS staff will bust a gut to deliver compassionate care, but with so many staff shortages, so little community care investment and so many waits for urgent treatment, the service is far from safe in 2017. The junior doctors were right. If we keep stretching the NHS, it will surely snap.
M.D.